Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
Shanghai Institute of Technology, Shanghai 201418, China.
Injury. 2024 Apr;55(4):111385. doi: 10.1016/j.injury.2024.111385. Epub 2024 Feb 3.
Pilon fractures represent a challenging subset of tibial fractures. The management of AO/OTA Type C3 fractures remains complex due to associated complications and lack of clear guidelines for surgical timing and methods. A prospective cohort study was conducted to evaluate two staged treatment strategies for AO/OTA Type C3 tibial pilon fractures. The study focused on assessing surgical difficulty, complications, and patient prognosis. One group of patients received early internal fixation of the fibula and tibial posterior column combined with external fixation, while the other group received external fixation alone in the first stage. Patients who received early internal fixation of the fibula and tibial posterior column combined with external fixation had better outcomes, including lower rate of allogeneic bone grafting (67.74 % versus 94.64 %), reduced incidence of wound delay and skin necrosis (3.23 % versus 21.43 %), shorter surgical time (133.06 ± 23.99 min versus 163.04 ± 26.83 min), shorter hospital stay (13.77 ± 2.53 days versus 18.25 ± 3.67 days), and higher AOFAS (83.05 ± 8.68 versus 79.36 ± 8.92). Additionally, avoiding fibular shortening was shown to be crucial in preventing prolonged surgery and improving patient function. The study demonstrated that the staged treatment approach with early internal fixation led to shorter operative times, improved ankle function, and reduced complications, including a lower risk of infection. The findings support the use of this treatment to optimize outcomes in AO/OTA Type C3 pilon fractures.
PILON 骨折是胫骨骨折中具有挑战性的一类。由于相关并发症和缺乏明确的手术时机和方法指南，AO/OTA 分型 C3 骨折的治疗仍然很复杂。一项前瞻性队列研究评估了两种分期治疗策略在治疗 AO/OTA 分型 C3 胫骨 pilon 骨折中的应用。该研究重点评估了手术难度、并发症和患者预后。一组患者接受腓骨和胫骨后柱的早期内固定联合外固定，另一组患者在第一阶段仅接受外固定。接受腓骨和胫骨后柱的早期内固定联合外固定的患者结果更好，包括异体骨移植率更低（67.74%对 94.64%），伤口延迟和皮肤坏死发生率更低（3.23%对 21.43%），手术时间更短（133.06±23.99min 对 163.04±26.83min），住院时间更短（13.77±2.53d 对 18.25±3.67d），AOFAS 评分更高（83.05±8.68 对 79.36±8.92）。此外，避免腓骨缩短对于缩短手术时间和改善患者功能至关重要。该研究表明，早期内固定的分期治疗方法可缩短手术时间，改善踝关节功能，并减少并发症，包括降低感染风险。研究结果支持采用这种治疗方法优化 AO/OTA 分型 C3 pilon 骨折的治疗效果。
